MEDICARE: DAISY MONTANO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	39158	TX

General Provider Information

NPI Number	:	1487363511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY MONTANO DDS

Provider Business Mailing Address
First Line	:	3636 FM 68
Second Line	:
City	:	WOLFE CITY
State	:	TX
Zip	:	75496-4822
Country	:	US
Telephone Number	:	903-486-4502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 THOMPSON RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4245
Country	:	US
Telephone Number	:	281-532-8183
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	11/17/2022

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Directions to “ DAISY MONTANO DDS” Practice Location

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